This document discusses ethics in nursing. It defines key terms like ethics and morality. Nursing ethics involves acting according to codes of ethics and principles like respect for autonomy, beneficence, nonmaleficence, and justice. Nurses are accountable and responsible for providing ethical care. Moral reasoning considers feelings, laws, and multiple perspectives in decision making. Ethical principles and frameworks help nurses navigate complex situations.

1. Ethics in NursingEthics in Nursing
Enie Novieastari, SKp.,MSNEnie Novieastari, SKp.,MSN
DKKD FIK UIDKKD FIK UI

2. List of contentsList of contents
 Definition of key termsDefinition of key terms
 Ethics in nursing careEthics in nursing care
 Nurses’ codes of ethicsNurses’ codes of ethics
 Accountability and responsibilityAccountability and responsibility
 Moral reasoning and theoriesMoral reasoning and theories
 Ethical principlesEthical principles
 Methodology for ethical decision makingMethodology for ethical decision making
 Institutional ethics committeeInstitutional ethics committee

3. What is ethics?What is ethics?
 A term with many meaningA term with many meaning
 Simply stated, it is concerned with how peopleSimply stated, it is concerned with how people
ought to act and how they ought to be inought to act and how they ought to be in
relationship with othersrelationship with others
 Concerned with establishing norms andConcerned with establishing norms and
standards for human life and conduct should bestandards for human life and conduct should be
 Good and bad, right and wrong, character orGood and bad, right and wrong, character or
motivesmotives
 Moral and ethics, used interchangeablyMoral and ethics, used interchangeably

4.  Etika: asal kata “ethos” (Yunani kuno)Etika: asal kata “ethos” (Yunani kuno)
dalam bentuk tunggal punya banyak arti:dalam bentuk tunggal punya banyak arti:
kandang; kebiasaan, adat; akhlak, watak;kandang; kebiasaan, adat; akhlak, watak;
perasaan, sikap, cara berpikir. Dalamperasaan, sikap, cara berpikir. Dalam
bentuk jamak “etha” yang berarti adatbentuk jamak “etha” yang berarti adat
kebiasaan (Bertens, 2007)kebiasaan (Bertens, 2007)
 EtikaEtika ~ moral~ moral dalam bahasa Latindalam bahasa Latin
berarti kebiasaan, adatberarti kebiasaan, adat
Secara etimologi etika dan moral samaSecara etimologi etika dan moral sama
artiarti

5. Menurut KBBI (1999)Menurut KBBI (1999)
 Etika berarti: ilmu tentang apa yang baik dan apaEtika berarti: ilmu tentang apa yang baik dan apa
yang buruk dan tentang hak dan kewajiban moralyang buruk dan tentang hak dan kewajiban moral
(akhlak)(akhlak)
 Etik berarti:Etik berarti:
1. kumpulan asas atau nilai yang1. kumpulan asas atau nilai yang
berkenaan dengan akhlakberkenaan dengan akhlak
2. nilai mengenai benar dan salah yang2. nilai mengenai benar dan salah yang
dianut suatu golongan atau masyarakatdianut suatu golongan atau masyarakat
 Etiket berarti:Etiket berarti:
1. secarik kertas yang ditempelkan pada kemasan1. secarik kertas yang ditempelkan pada kemasan
2. tatacara (adat, sopan santun dsb) dalam2. tatacara (adat, sopan santun dsb) dalam
masyarakatmasyarakat

6.  Values and ethics are relatedValues and ethics are related
 Values: building blocks for personal andValues: building blocks for personal and
professional morality, influence one’s ethicalprofessional morality, influence one’s ethical
decision making, relationship and conductdecision making, relationship and conduct
 Values are based on experience, religion,Values are based on experience, religion,
education, and cultureeducation, and culture
 A person’s ethic flows from his/her valuesA person’s ethic flows from his/her values
 Ethics is a study of good conduct, character, andEthics is a study of good conduct, character, and
motives, and concerned with determining what ismotives, and concerned with determining what is
good or valuable for all peoplegood or valuable for all people

7. Ethics in nursing careEthics in nursing care
 In nursing, specific values and moralIn nursing, specific values and moral
requirements are necessary to maintainrequirements are necessary to maintain
integrity of the professionintegrity of the profession
 An ethical nurse will act and treat others inAn ethical nurse will act and treat others in
specific ways that are consistent with thespecific ways that are consistent with the
nursing norms and will be guided by morenursing norms and will be guided by more
than personal preferences or valuesthan personal preferences or values

8. An ethic of careAn ethic of care
 Care: an action, a virtue, an affect, an ethicalCare: an action, a virtue, an affect, an ethical
principle, or a way of being in the worldprinciple, or a way of being in the world
 Care as an ethic for nursing is concerned notCare as an ethic for nursing is concerned not
only with the resolution of ethical dilemmas, butonly with the resolution of ethical dilemmas, but
also with the ways people behave towards onealso with the ways people behave towards one
anotheranother
 An ethic of care is concerned with relationshipAn ethic of care is concerned with relationship
between people and with a nurse’s characterbetween people and with a nurse’s character
and attitude toward others.and attitude toward others.

9. Nurses Code of EthicsNurses Code of Ethics
 Nursing has developed code of ethics thatNursing has developed code of ethics that
describe ideals for professional conductdescribe ideals for professional conduct
 Codes reflect ethical principles widely acceptedCodes reflect ethical principles widely accepted
by members of the professionsby members of the professions
 See Kode Etik Keperawatan Indonesia:See Kode Etik Keperawatan Indonesia:
- Perawat dan klien- Perawat dan klien
- Perawat dan praktek- Perawat dan praktek
- Perawat dan masyarakat- Perawat dan masyarakat
- Perawat dan teman sejawat- Perawat dan teman sejawat
- Perawat dan profesi- Perawat dan profesi

10. Accountability and responsibilityAccountability and responsibility
 Nurse assumes responsibility and accountability forNurse assumes responsibility and accountability for
nursing care providednursing care provided
 Responsibility: execution of duties associated with theResponsibility: execution of duties associated with the
nurse’s particular rolenurse’s particular role
Example: when administering the meds, the nurse isExample: when administering the meds, the nurse is
responsible for assessing the client’s need for the drug,responsible for assessing the client’s need for the drug,
giving them safely and correctly, and evaluating thegiving them safely and correctly, and evaluating the
responsesresponses
 A nurse who acts in a responsible manner gains the trustA nurse who acts in a responsible manner gains the trust
of client and other professionalsof client and other professionals
 A responsible nurse: competent in knowledge and skillsA responsible nurse: competent in knowledge and skills
and demonstrates a willingness to perform within theand demonstrates a willingness to perform within the
ethical guidelines of the professionsethical guidelines of the professions

11.  Accountability means being answerable forAccountability means being answerable for
one’s own actionsone’s own actions
 A nurse is accountable to self, the client, theA nurse is accountable to self, the client, the
profession, the employer, and societyprofession, the employer, and society
 If a wrong dose of meds given, the nurse isIf a wrong dose of meds given, the nurse is
accountable to the client who receive it, theaccountable to the client who receive it, the
physician who ordered it, the nursing servicephysician who ordered it, the nursing service
that set standard of expected performance, andthat set standard of expected performance, and
the society, which demands professionalthe society, which demands professional
excellenceexcellence
 To be accountable, the nurse acts according toTo be accountable, the nurse acts according to
the professional code of ethicsthe professional code of ethics

12. The purpose of professional accountability:,The purpose of professional accountability:,
 To evaluate new professional practicesTo evaluate new professional practices
and reassess existing onesand reassess existing ones
 To maintain standards of health careTo maintain standards of health care
 To facilitate personal reflection, ethicalTo facilitate personal reflection, ethical
thought, and personal growth on the partthought, and personal growth on the part
of health care professionalsof health care professionals
 To provide a basis for ethical decisionTo provide a basis for ethical decision
makingmaking

13. Moral reasoningMoral reasoning
 ““Doing ethics” involves participating in a criticalDoing ethics” involves participating in a critical
thought process about right and wrong, goodthought process about right and wrong, good
and bad, or thinking about situationsand bad, or thinking about situations
 A process that occurs in many client-nurseA process that occurs in many client-nurse
interactioninteraction
 Developing an understanding of the complexDeveloping an understanding of the complex
thought process (moral reasoning) involved inthought process (moral reasoning) involved in
processing ethical situations helps nursesprocessing ethical situations helps nurses
participate more fully in the discussionsparticipate more fully in the discussions
 Most moral reasoning happens after an ethicalMost moral reasoning happens after an ethical
situation has been recognized and before onesituation has been recognized and before one
acts on the situationacts on the situation

14.  Emotions play an important role in ethicalEmotions play an important role in ethical
reasoningreasoning
 People feelings or emotions are different andPeople feelings or emotions are different and
change in the same person from day to day orchange in the same person from day to day or
hour to hourhour to hour
 Feelings should be honored, acknowledged, andFeelings should be honored, acknowledged, and
used as a consideration in moral reasoningused as a consideration in moral reasoning
without making ethics simply a discussion aboutwithout making ethics simply a discussion about
the validity and sincerity of individual’s feelingthe validity and sincerity of individual’s feeling
 Ethics is concerned with developing a system ofEthics is concerned with developing a system of
shared values in a pluralistic societyshared values in a pluralistic society

15.  Legal considerations also affect moral reasoningLegal considerations also affect moral reasoning
 It is important to consider the law, the policies, orIt is important to consider the law, the policies, or
the guidelines of policy and procedure in moralthe guidelines of policy and procedure in moral
thinkingthinking
 Ethics and laws are often in harmony, but notEthics and laws are often in harmony, but not
alwaysalways
 Relying on law as the primary consideration ofRelying on law as the primary consideration of
moral standards is a form of legalismmoral standards is a form of legalism
 For example: refuse to act the request aFor example: refuse to act the request a
terminally ill, competent client to stop treatment,terminally ill, competent client to stop treatment,
because of practitioners are afraid of being suedbecause of practitioners are afraid of being sued

16. Ethical principlesEthical principles
 The most fundamental principle: respectThe most fundamental principle: respect
for personsfor persons
 The 4 other primary principles stem fromThe 4 other primary principles stem from
this basic principle:this basic principle:
1. respect for autonomy1. respect for autonomy
2. beneficence2. beneficence
3. nonmaleficence3. nonmaleficence
4. justice4. justice

17.  Autonomy: individual should have freedomAutonomy: individual should have freedom
to choose their own life plan and ways ofto choose their own life plan and ways of
being moralbeing moral
 The principles of nonmaleficence andThe principles of nonmaleficence and
beneficence are viewed on a continuumbeneficence are viewed on a continuum
ranging from not inflicting harmranging from not inflicting harm
(nonmaleficence) to benefiting others by(nonmaleficence) to benefiting others by
doing good (beneficence)doing good (beneficence)
 Justice: treating others fairly and givingJustice: treating others fairly and giving
persons their duepersons their due

18.  The secondary principles:The secondary principles:
- veracity: the duty to tell the truth- veracity: the duty to tell the truth
- confidentiality; the duty to protect privileged- confidentiality; the duty to protect privileged
informationinformation
- fidelity: the duty to keep promises- fidelity: the duty to keep promises
 Informed consent: promotes and respectsInformed consent: promotes and respects
autonomy by expanding the client’s knowledgeautonomy by expanding the client’s knowledge
of his/her opinionsof his/her opinions
 Advance directives: a form of communication inAdvance directives: a form of communication in
which the persons can give direction on howwhich the persons can give direction on how
they would like to be treated when they cannotthey would like to be treated when they cannot
speak for themselvesspeak for themselves

19. Case for discussionCase for discussion
 A woman was receiving treatment for advance cancer inA woman was receiving treatment for advance cancer in
a large hospital. Her condition deteriorated anda large hospital. Her condition deteriorated and
meaningful recovery from her illness was highly unlikely.meaningful recovery from her illness was highly unlikely.
She was taken to an intensive care unit for impendingShe was taken to an intensive care unit for impending
respiratory failure. She was competent and indicated thatrespiratory failure. She was competent and indicated that
she did not want any further aggressive medicalshe did not want any further aggressive medical
therapies but believed she needed the approval of thetherapies but believed she needed the approval of the
male members of her family (her brothers), who lived inmale members of her family (her brothers), who lived in
other city. Efforts were made to contact them and theyother city. Efforts were made to contact them and they
indicated that they would come. Because they had 2indicated that they would come. Because they had 2
days of travel time, she had to be placed on a regimendays of travel time, she had to be placed on a regimen
of ventilator therapy and blood pressure medication toof ventilator therapy and blood pressure medication to
prolong her life until they could arrive and decide what toprolong her life until they could arrive and decide what to
do. The nurse felt moral distress because she believeddo. The nurse felt moral distress because she believed
that the client should have been able to make thethat the client should have been able to make the
decision about her own life and death by her self. Itdecision about her own life and death by her self. It
seemed wrong that she have to defer to the decision ofseemed wrong that she have to defer to the decision of
her brothersher brothers

20. Kerangka pemecahan masalah etikKerangka pemecahan masalah etik
 Mengembangkan data dasarMengembangkan data dasar
 Mengidentifikasi konflikMengidentifikasi konflik
 Membuat tindakan alternatifMembuat tindakan alternatif
 Menentukan siapa yang terlibat dan siapaMenentukan siapa yang terlibat dan siapa
pengambil keputusanpengambil keputusan
 Mengidentifikasi kewajiabn perawatMengidentifikasi kewajiabn perawat
 Membuat keputusanMembuat keputusan

21. Pengambilan keputusan etisPengambilan keputusan etis
 Menunjukkan maksud baik yang relevanMenunjukkan maksud baik yang relevan
 Mengidentifikasi semua orang yangMengidentifikasi semua orang yang
pentingpenting
 Mengumpulkan informasi yang relevanMengumpulkan informasi yang relevan
 Mengidentifikasi prinsip etis yang pentingMengidentifikasi prinsip etis yang penting
 Mengusulkan tindakan alternatifMengusulkan tindakan alternatif
 Melakukan tindakanMelakukan tindakan

22. ReferencesReferences
 Some text book in fundamentals nursing &Some text book in fundamentals nursing &
ethicsethics